The law streamlines the bulky credentialing process required for nurse practitioners to treat patients in Maryland. A process that now requires approvals by separate boards of doctors and nurses –- and can take up to six months — will be shortened to about a month, cutting the standard 19-page working agreement between nurses and doctors to a single page.

The new law could free up more nurses to treat patients, said Jane Kapustin, assistant dean for master's programs at the University of Maryland School of Nursing. "So many people in Maryland have no primary care that it was time to remove barriers and provide more access to patients."

Maryland's 3,200 nurse practitioners have many of the responsibilities of a doctor — they can diagnose and treat patients and prescribe medicine. They need to have graduated from an approved nursing school and be certified by the nursing board. And while many work independently, they must collaborate with physicians in order to treat patients.

The new law doesn't change that arrangement, but makes the process less cumbersome. Most importantly, nurses would be freed up more to treat patients, Kapustin said.

With the passage of federal health care reform legislation, the need for more primary care is acute, she said. Expanding health insurance to 32 million Americans will strain a system that doesn't have enough doctors, particularly in rural areas, providers say. Nurse practitioners can help fill a vital role now more than ever, said Del. Sue Kullen, a Calvert County Democrat who sponsored the legislation in the House.

"Access to care is the biggest issue," she said. "And this will free up nurse practitioners to practice more independently within their scope of practice."

Nurse practitioners wanted the legislation to be more sweeping, abandoning the agreements with doctors entirely and making their practices completely independent. But the state's doctors pushed back, saying the agreements were essential to good patient care.

"Nurse practitioners provide a very valuable role, but they don't have the education and training that doctors have," said Gene Ransom III, chief executive of Med Chi, the state's medical society. "But our physicians were very supportive of reducing the bureaucracy they face. You get more people involved in caring for patients, and it makes it easier for our physicians to hire a nurse practitioner. It is a good thing for primary care."

Removing barriers also means keeping nurse practitioners in the state, said Susan Delean-Botkin, legislative chairwoman of the Nurse Practitioner Association of Maryland. She estimates that 10 percent to15 percent of the state's nurse practitioners have fled Maryland in the past four years to states with less stringent requirements for practicing.

Keeping nurse practitioners tied to a formal agreement doctors with has meant struggles for patients, too, she said.

When a doctor retires, moves or closes a practice, the nurse practitioner can no longer provide for patients.

"In rural areas, they literally have no one to care for them," Delean-Botkin said. "Nurse practitioners frequently lived in fear if their physician retired or left their practice. This will enable the nurse practitioner to stay in place."

The signing comes as more than 20 other states are looking to address primary care shortages by broadening the role of nurse practitioners.